Health Profession Intent Form

Submit the following information to register your interest in preparing for a Health Profession. Update your information as often as necessary to remain current and maintain your status as an active participant in the Pre-med or Pre-health Program.
After your original submission, fill in only your name, CNU student ID# and email address (preferably your CNU email address), and any information updates.
**If your semester hours are not updated each semester, your intent will become inactive and you will not receive important prehealth updates and information!**

* Required

First Name
*

Last Name
*

Email
*

CNU Student ID Number
*

Phone Number

Cell Phone Number

CNU Address or Local Address

Only one is required (either Residence Hall and Box Number or Local Address, City, State, Zip)

Residence Hall

Mailbox Number

Local Address

City

Zip

Permanent Home Address

Address

City

State

Zip

Education Info

Semester Entering CNU

Year Entering CNU

Major

Minor

Semester Hours Completed
*If you are a new student to CNU, please insert "1" in this field. If you are a transfer student, enter the number of semester hours you have already completed.